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Papers by Enrique La Orden Izquierdo
Archivos españoles de urología, Nov 1, 2022
Journal of Pediatric Gastroenterology & Nutrition
Frontiers in Pediatrics, 2020
Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory b... more Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the Jiménez Treviño et al. Pediatric IBD Diagnostic Delay in Spain DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.
Anales de Pediatría (English Edition), 2020
Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and ... more Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and is characterised by symptoms of oesophageal dysfunction and inflammation with isolated eosinophil infiltration in the oesophagus. It is more common in males and in atopic subjects, and the symptoms vary with age. In younger children, there is vomiting, abdominal pain and dietary problems, with dysphagia and food impaction in older children and adolescents. The diagnosis is based on the presence of symptoms and oesophageal inflammation with ≥15 eosinophils/high power field, and after ruling out other causes of oesophageal eosinophilia. Without treatment, the disease usually persists and can progress to fibrostenotic forms more common in adults. The treatment options included proton pump inhibitors, empirical elimination diets, and swallowed topical corticosteroids. Maintenance therapy is advisable after the induction treatment. Diet is the only treatment that is directed at the cause of the disease, on identifying the triggering food or foods. The response to the treatments requires a histological assessment due to the poor agreement between the symptoms and the oesophageal inflammation.
Manual de pediatría, 2019, ISBN 978-84-17194-65-9, págs. 905-908, 2019
Revista Pediatría de Atención Primaria, 2016
Las recomendaciones de introduccion de la alimentacion complementaria han variado paralelamente a... more Las recomendaciones de introduccion de la alimentacion complementaria han variado paralelamente al incremento de la incidencia de enfermedad celiaca, alergias e intolerancias alimentarias y de obesidad infantojuvenil, base de muchas enfermedades cronicas del adulto. Existen controversias sobre cuando es el momento idoneo de inicio, que alimento es el mas adecuado y cual es la forma de presentar esos alimentos al lactante para mejorar el comportamiento alimentario. No existen guias especificas para lactantes con alto riesgo alergico o prematuros. El baby-led weaning se ha propuesto como una manera relajada para incorporar al lactante al patron familiar de alimentacion. La evidencia actual apoya que la respuesta a todas estas preguntas se encuentra en el grado de maduracion y necesidades especificas de cada lactante; sin embargo, la controversia esta servida.
Anales de pediatria, 2021
INTRODUCTION Helicobacter pylori (H. pylori) infection affects more than 50% of the world populat... more INTRODUCTION Helicobacter pylori (H. pylori) infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. PATIENTS AND METHODS retrospective descriptive study of all microbiological isolates of H. pylori in 2013-2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013-2016 and 2017-2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. RESULTS 192 patients were included, 98 were detected by culture (2013-2016) and 94 by...
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in ach... more Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels...
Introduccion: La esofagitis eosinofilica (EEo) es un proceso inflamatorio cronico local, mediado ... more Introduccion: La esofagitis eosinofilica (EEo) es un proceso inflamatorio cronico local, mediado inmunologicamente, caracterizado clinicamente por sintomas sugerentes de disfuncion esofagica e histologicamente por una infiltracion eosinofilica del epitelio esofagico. Su incidencia esta aumentando en nuestro medio y su historia natural no es completamente conocida. En la actualidad se postula que los neumoalergenos pueden tener un papel como desencadenantes de la enfermedad o agravantes de su sintomatologia. Pacientes y metodos: Se diseno un estudio observacional prospectivo longitudinal multicentrico incluyendo todos los pacientes diagnosticados de EEo entre septiembre de 2014 y agosto de 2016 en las unidades de Gastroenterologia Pediatrica de los 12 hospitales publicos del suroeste de la Comunidad de Madrid. Se valoro la incidencia en relacion a la poblacion de referencia de forma global, por grupos de edad y area geografica, asi como la estacionalidad en el diagnostico. Ademas, se...
Pediatric Allergy and Immunology
Archivos españoles de urología, Nov 1, 2022
Journal of Pediatric Gastroenterology & Nutrition
Frontiers in Pediatrics, 2020
Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory b... more Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the Jiménez Treviño et al. Pediatric IBD Diagnostic Delay in Spain DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.
Anales de Pediatría (English Edition), 2020
Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and ... more Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and is characterised by symptoms of oesophageal dysfunction and inflammation with isolated eosinophil infiltration in the oesophagus. It is more common in males and in atopic subjects, and the symptoms vary with age. In younger children, there is vomiting, abdominal pain and dietary problems, with dysphagia and food impaction in older children and adolescents. The diagnosis is based on the presence of symptoms and oesophageal inflammation with ≥15 eosinophils/high power field, and after ruling out other causes of oesophageal eosinophilia. Without treatment, the disease usually persists and can progress to fibrostenotic forms more common in adults. The treatment options included proton pump inhibitors, empirical elimination diets, and swallowed topical corticosteroids. Maintenance therapy is advisable after the induction treatment. Diet is the only treatment that is directed at the cause of the disease, on identifying the triggering food or foods. The response to the treatments requires a histological assessment due to the poor agreement between the symptoms and the oesophageal inflammation.
Manual de pediatría, 2019, ISBN 978-84-17194-65-9, págs. 905-908, 2019
Revista Pediatría de Atención Primaria, 2016
Las recomendaciones de introduccion de la alimentacion complementaria han variado paralelamente a... more Las recomendaciones de introduccion de la alimentacion complementaria han variado paralelamente al incremento de la incidencia de enfermedad celiaca, alergias e intolerancias alimentarias y de obesidad infantojuvenil, base de muchas enfermedades cronicas del adulto. Existen controversias sobre cuando es el momento idoneo de inicio, que alimento es el mas adecuado y cual es la forma de presentar esos alimentos al lactante para mejorar el comportamiento alimentario. No existen guias especificas para lactantes con alto riesgo alergico o prematuros. El baby-led weaning se ha propuesto como una manera relajada para incorporar al lactante al patron familiar de alimentacion. La evidencia actual apoya que la respuesta a todas estas preguntas se encuentra en el grado de maduracion y necesidades especificas de cada lactante; sin embargo, la controversia esta servida.
Anales de pediatria, 2021
INTRODUCTION Helicobacter pylori (H. pylori) infection affects more than 50% of the world populat... more INTRODUCTION Helicobacter pylori (H. pylori) infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. PATIENTS AND METHODS retrospective descriptive study of all microbiological isolates of H. pylori in 2013-2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013-2016 and 2017-2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. RESULTS 192 patients were included, 98 were detected by culture (2013-2016) and 94 by...
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in ach... more Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels...
Introduccion: La esofagitis eosinofilica (EEo) es un proceso inflamatorio cronico local, mediado ... more Introduccion: La esofagitis eosinofilica (EEo) es un proceso inflamatorio cronico local, mediado inmunologicamente, caracterizado clinicamente por sintomas sugerentes de disfuncion esofagica e histologicamente por una infiltracion eosinofilica del epitelio esofagico. Su incidencia esta aumentando en nuestro medio y su historia natural no es completamente conocida. En la actualidad se postula que los neumoalergenos pueden tener un papel como desencadenantes de la enfermedad o agravantes de su sintomatologia. Pacientes y metodos: Se diseno un estudio observacional prospectivo longitudinal multicentrico incluyendo todos los pacientes diagnosticados de EEo entre septiembre de 2014 y agosto de 2016 en las unidades de Gastroenterologia Pediatrica de los 12 hospitales publicos del suroeste de la Comunidad de Madrid. Se valoro la incidencia en relacion a la poblacion de referencia de forma global, por grupos de edad y area geografica, asi como la estacionalidad en el diagnostico. Ademas, se...
Pediatric Allergy and Immunology